PURPOSE: There is no clear consensus on how to treat patients undergoing coronary artery bypass grafting (CABG) who have severe concomitant carotidcerebral artery stenosis. The aim of this study was to evaluate our surgical results in patients with severe carotid and/or cerebrovascular disease undergoing CABG. METHODS: Between October 2003 and April 2009, a total of 47 such patients were treated at our institution with the following strategies: (1) protective carotid artery stenting for severe carotid stenosis performed either before (n = 20) or after (n = 5) CABG or (2) a superficial temporal artery-middle cerebral artery anastomosis procedure followed by CABG if indicated (n = 4). Off-pump CABG was performed in 75% of the patients. RESULTS: There were no major perioperative strokes or in-hospital deaths; however, three patients had transient ischemic attacks and two had minor strokes during the early post-CABG period. All of the patients with postoperative cerebrovascular events had had unilateral carotid artery occlusion. There were no late deaths during the follow-up period (up to 6 years, with a mean of 27 months). However, major adverse cardiocerebrovascular events (MACCE) occurred in seven patients (14.9%). The rates of freedom from MACCE at 1 and 3 years were 92% and 74%, respectively. CONCLUSION: It appears that our two-staged approach is safe and may reduce the risk of postoperative cerebrovascular events.
PURPOSE: There is no clear consensus on how to treat patients undergoing coronary artery bypass grafting (CABG) who have severe concomitant carotidcerebral artery stenosis. The aim of this study was to evaluate our surgical results in patients with severe carotid and/or cerebrovascular disease undergoing CABG. METHODS: Between October 2003 and April 2009, a total of 47 such patients were treated at our institution with the following strategies: (1) protective carotid artery stenting for severe carotid stenosis performed either before (n = 20) or after (n = 5) CABG or (2) a superficial temporal artery-middle cerebral artery anastomosis procedure followed by CABG if indicated (n = 4). Off-pump CABG was performed in 75% of the patients. RESULTS: There were no major perioperative strokes or in-hospital deaths; however, three patients had transient ischemic attacks and two had minor strokes during the early post-CABG period. All of the patients with postoperative cerebrovascular events had had unilateral carotid artery occlusion. There were no late deaths during the follow-up period (up to 6 years, with a mean of 27 months). However, major adverse cardiocerebrovascular events (MACCE) occurred in seven patients (14.9%). The rates of freedom from MACCE at 1 and 3 years were 92% and 74%, respectively. CONCLUSION: It appears that our two-staged approach is safe and may reduce the risk of postoperative cerebrovascular events.
Authors: Luis A Guzman; Marco A Costa; Dominick J Angiolillo; Martin Zenni; Peter Wludyka; Scott Silliman; Theodore A Bass Journal: Stroke Date: 2008-01-03 Impact factor: 7.914
Authors: Francesco Versaci; Costantino Del Giudice; Antonio Scafuri; Jacob Zeitani; Roberto Gandini; Paolo Nardi; Alessandro Salvati; Enrico Pampana; Fabiano Sebastiano; Andrea Romagnoli; Giovanni Simonetti; Luigi Chiariello Journal: Ann Thorac Surg Date: 2007-11 Impact factor: 4.330
Authors: Ralph L Sacco; Robert Adams; Greg Albers; Mark J Alberts; Oscar Benavente; Karen Furie; Larry B Goldstein; Philip Gorelick; Jonathan Halperin; Robert Harbaugh; S Claiborne Johnston; Irene Katzan; Margaret Kelly-Hayes; Edgar J Kenton; Michael Marks; Lee H Schwamm; Thomas Tomsick Journal: Circulation Date: 2006-03-14 Impact factor: 29.690
Authors: Hitinder S Gurm; Jay S Yadav; Pierre Fayad; Barry T Katzen; Gregory J Mishkel; Tanvir K Bajwa; Gary Ansel; Neil E Strickman; Hong Wang; Sidney A Cohen; Joseph M Massaro; Donald E Cutlip Journal: N Engl J Med Date: 2008-04-10 Impact factor: 91.245
Authors: Garrett K Peel; Sotiris C Stamou; Mercedes K C Dullum; Peter C Hill; Kathleen A Jablonski; Ammar S Bafi; Steven W Boyce; Kathleen R Petro; Paul J Corso Journal: J Am Coll Cardiol Date: 2004-03-03 Impact factor: 24.094